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Changes in cardiac function and cerebral blood flow in relation to peri/intraventricular hemorrhage in extremely

Shahab Noori1, Michael McCoy2, Michael P Anderson3

  • 1Division of Neonatology and the Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles and the LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA.

The Journal of Pediatrics
|November 5, 2013
PubMed

Insights

Changes in cardiac function and cerebral blood flow (CBF) precede peri/intraventricular hemorrhage (P/IVH) in preterm infants. Monitoring these parameters may help identify high-risk neonates before bleeding occurs.

Area of Science:

  • Neonatal physiology
  • Cardiovascular research
  • Neurology

Background:

  • Peri/intraventricular hemorrhage (P/IVH) is a significant complication in extremely preterm infants.
  • Early detection of risk factors for P/IVH is crucial for timely intervention.

Purpose of the Study:

  • To determine if alterations in cardiac function and cerebral blood flow (CBF) precede P/IVH in extremely preterm neonates.
  • To assess the potential of monitoring cardiac function and CBF for predicting P/IVH.

Main Methods:

  • Prospective observational study of 22 preterm infants (23-27 weeks gestational age).
  • Cardiac function, CBF, and P/IVH assessed via ultrasound every 12 hours.
  • Continuous monitoring of cerebral regional oxygen saturation (rSO2) and cerebral fractional oxygen extraction.

Main Results:

  • Infants who developed P/IVH showed decreased left ventricular output, stroke volume, and cerebral rSO2, with increased cerebral fractional oxygen extraction within the first 12 hours.
  • These hemodynamic and CBF changes preceded the ultrasonographic detection of P/IVH.
  • Myocardial performance index and middle cerebral artery flow velocity also differed between groups by 28 hours.

Conclusions:

  • Cardiac function and CBF are stable in preterm neonates without P/IVH in the first 3 postnatal days.
  • In neonates who develop P/IVH, reduced systemic perfusion and CBF, followed by an increase, precede hemorrhage.
  • Monitoring cardiac function and cerebral rSO2 may identify infants at high risk for P/IVH development.
Abstract

Keywords:
Arterial oxygen saturationCBFCFOECO(2)Carbon dioxideCerebral blood flowCerebral fractional oxygen extractionHeart rate-corrected velocity of circumferential fiber shorteningLVOLeft ventricular outputMCAMCA mean velocityMCA-MVMPIMiddle cerebral arteryMyocardial performance indexNIRSNear-infrared spectroscopyP/IVHPDAPatent ductus arteriosusPeri/intraventricular hemorrhageRVORegional oxygen saturationRight ventricular outputSVRSpO(2)Systemic vascular resistanceUSUltrasoundVCF(C)rSO(2)

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